The following are key perspectives from this protocol about personal protective equipment (PPE) for angiography during the COVID-19 crisis, from the Tygerberg Hospital & Stellenbosch University, Cape Town, South Africa:

Donning of PPE

1. Surgical scrubs to be worn. These will need to be changed with each case if a COVID-positive case is treated or there is any concern about soiling. No jewelry to be worn. Scrub top to be tucked into scrub pants.
2. Thorough washing of hands for at least 20 seconds prior to initiating the donning process.
3. Shoe covers to be initially donned.
4. Thereafter, prior to scrubbing, don the N95 respirator mask with the surgical scrub cap over the N95 mask. A second method for eye protection should be used and worn over the respirator and scrub cap. This protocol recommends a surgical mask with a visor be used for eye protection. Disposable face shields may also be used. Surgical safety goggles can be used as an alternative but will need to be sterilized after each case. Healthcare workers should ideally have N95 respirator masks fit-tested and the correct size respirator mask should be used.
5. The scrub cap should cover both ears.
6. Prescription glasses/lead glasses on their own are not enough for protection. The visor should adequately cover both eyes and provide some protection to the side of the face. Put on usual radiation protection equipment as used.
7. Thoroughly scrub hands to the level of the elbows using an antibacterial surgical scrub and warm water and prepare to gown. Disposable surgical gown to be worn. Take care to ensure that gown sleeves do not go beyond wrists as it is put on. Ensure that the top of the gown covers as much of the exposed neck area as possible
8. This hospital protocol recommends a two-glove technique. Put on two pairs of gloves ensuring that both gloves fit snugly and cover the sleeves of the gown.

Doffing of PPE

1. There is a very high risk of contamination and therefore another individual should watch you doffing the PPE and alert you to any possibility of contamination.
2. Wash/clean the outer pair of gloves in water and thereafter remove the outer pair without touching the outside surface of the inner pair of gloves, and discard into a medical waste bin.
3. Remove shoe-covers and discard (performed more easily if sitting on a chair).
4. There is contention as to whether one should wash hands/gloves with alcohol during each step of doffing. This institution recommends cleaning hands between every step of the procedure.
5. Clean internal pair of gloves with alcohol.
6. Remove the visor without touching the front/exposed surface of the visor and dispose directly into medical waste bin.
7. Clean internal pair of gloves with alcohol (again – second time).
8. Remove the disposable gown by grasping the inside surface of the gown at the collar and rolling the gown away from you without touching the exposed surface of the gown.
9. Clean internal pair of gloves with alcohol (again – third time).
10. Remove scrub cap.
11. Clean internal pair of gloves with alcohol and then remove (fourth and final alcohol clean of internal gloves).
12. Remove radiation protection.
13. Clean hands with alcohol.
14. Remove N95 respirator mask by pulling the elastics over one’s head and discard the mask without touching the exposed surface of the mask. The respirator is removed last to reduce the likelihood of exposure to aerosolized droplets during doffing.
15. Wash hands with soap and warm water.
16. Radiation protection should be cleaned with an alcohol scrub, surgical scrubs should be washed, and the chair used during doffing of overshoes should be cleaned with an alcohol scrub.
17. There is a recommendation that you then take a shower, but the operators at this hospital aim to shower only before leaving the hospital.

Clinical Topics: COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Coronary Angiography, Coronavirus, COVID-19, Ethanol, Eye Protective Devices, Gloves, Protective, Masks, Medical Waste Disposal, Primary Prevention, Protective Clothing, Radiation Protection, Respiratory Protective Devices, severe acute respiratory syndrome coronavirus 2

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